Military MedPeds program

[Scooby007]

I am a third year HPSP student and interested in a combined Internal Medicine/Pediatrics residency (MedPeds). From what I have searched, the Army doesn't offer this program, nor do they encourage combined programs.

From my previous military experience and the loop-holes I had to jump through to get into medical school, I've found that for every rule, there is an exception.

Does anyone have any thoughts or idea on how to obtain a MedPeds program as a military residency? Would any of the department heads at an Army teach hospital be keen on integrating this as an accredited program or should I entertain pursuing this as a civilian residency (which will just as difficult since I'll probably be slated in an Army program).

Any thoughts are welcome!

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[IgD]

Match in IM
Do your utilization tour
Complete a military peds residency
Do another utilization tour

 

[TheGoose]

this question came up in a recent thread and the general consensus was that since the military cant really use you as a med/peds but rather as a med OR peds, that they dont let you do combined programs.

 

[delicatefade]

Although they will let you do an IM/Psych program and then use you as a psychiatrist.

 

[J-Rad]

The Air Force also will not allow initial training in Med-Peds. I know there are one to a few Med-Peds folks in the Navy, though I am unsure of the circumstances in which they trained (I realize that that info is not pertinent to you, just a sidenote).

 

[TheGoose]

The Air Force also will not allow initial training in Med-Peds. I know there are one to a few Med-Peds folks in the Navy, though I am unsure of the circumstances in which they trained (I realize that that info is not pertinent to you, just a sidenote).

could always be FAP or just a direct commission post-training.

 

[orbitsurgMD]

I am a third year HPSP student and interested in a combined Internal Medicine/Pediatrics residency (MedPeds). From what I have searched, the Army doesn't offer this program, nor do they encourage combined programs.

From my previous military experience and the loop-holes I had to jump through to get into medical school, I've found that for every rule, there is an exception.

Does anyone have any thoughts or idea on how to obtain a MedPeds program as a military residency? Would any of the department heads at an Army teach hospital be keen on integrating this as an accredited program or should I entertain pursuing this as a civilian residency (which will just as difficult since I'll probably be slated in an Army program).

Any thoughts are welcome!

Unfortunately, the services won't see more utility in you (as a doctor dual-boarded) than they would if you did family practice. So to them, you might as well do FP (not that it helps you or that they care about the difference in practice emphasis in FP vs Med/Peds.)

 

[Scooby007]

Well that stinks!

You would think that they would see the benefit in having me duel certified - able to fill more slots when I PCS or provide a more broad spectrum of care when I am deployed. Aside from the fact MedPeds can help provide for the continuity of care of special need family members (i.e. in the Exceptional Family Member Program when making the transition from their pediatrician to an internist).

Why won't the military allow formally trained doctors (i.e. duel certified - I know of some in the military) to work in both the Pediatric and Medicine wards? It always amazes me how those in charge of my paperwork have little knowledge in medical management and cannot think outside of the box...

Also, with respect to the first comment - is it difficult to do a second residency in the military (i.e. the IM then Peds you suggested?).

Thanks!

 

[RugbyJC]

Well that stinks!

Why won't the military allow formally trained doctors (i.e. duel certified - I know of some in the military) to work in both the Pediatric and Medicine wards? It always amazes me how those in charge of my paperwork have little knowledge in medical management and cannot think outside of the box...

Also, with respect to the first comment - is it difficult to do a second residency in the military (i.e. the IM then Peds you suggested?).

Thanks!

Its probably easier to do a second residency in the military compared to civilian, but you usually need to serve your committment in whatever you train in first. Part of the reason is that you are paid by your rank and not based on that you are in residency, while civilian your pay is that of a resident and you can't always get funding to do a program once you are already trained.

Even civilian, IM/Peds docs tend to do either one or the other specialty or serve as FPs/Doc in the Boxes unless they do a fellowship. Not always the case, but few places will allow them to fully utilize their training and the amount of knowledge needed to stay uptodate in both areas can be overwhelming...this is from my former med school advisor who was med/peds trainined, but worked as an FP. I don't have any personal experience with this other than that it was one of the 45 specialties I considered when applying for internship.

 

[delicatefade]

People who do med/peds typically:

-don't really want to do any OB during residency.
-feel that med/peds gives a deeper knowledge base rather than the more broad knowledge base of FP
-like the inpatient focus of med/peds rather than the outpatient focus of most FP programs


we had a couple from my school do med/peds this year and these were their thoughts.

 

[Scooby007]

And those are exactly my wishes - but apparantly the military doesn't see the difference between MedPeds and FP.

If anyone still has any other thoughts on what route I should take, I'm option to all options. Also, do you think the department heads at Army teaching hospitals would be keen on creating a MedPeds program in the near future?

 

[Gastrapathy]

I can't imagine military medicine wanting to train anyone in Med/Peds. We need internists and pediatricians but you can only do one job at a time. You won't fill two billets because each is a fulltime job.

While you might have a little more inpatient experience after a Med/Peds residency than an FP residency, I don't think you'll be "better" than a FP with a couple years of practice. Furthermore, I think the military FP programs are pretty rigorous. The friends of mine who trained in FP at a couple of sites took way more call than I did in a Navy IM program.

Residency programs exist in Med/Peds because trainees want them, not because they serve any particularly useful purpose. I'm willing to bet you won't see that coming anytime soon.

As for expecting the people in charge to "think outside of the box", what kind of job do you envision yourself doing as a staff physician? Do you really think the other IM or Peds staff will care about your being double-boarded and somehow give you special treatment?

 

[Scooby007]

Nothing was mentioned about 'special treatment'. And 'thinking outside of the box' was referring to those in the HPSP office who can only imagine a MedPeds doctor filling either a pediatrics or internist slot at one time versus the integrated positions offered at civilian hospitals. But maybe the 3 hospitals affiliated with my school are unique - the MedPeds physicians on staff float between the ICU and PICU and inpatient wards in both IM and Peds.

I was hoping the military would see the cost benefit of this integrated thinking. Plus, the capability of providing a better continuity of care for special needs patients (i.e. in the Exceptional Family Member Program) as they transition from pediatricians to internists. Just my thoughts.

And I am still interested in MedPeds so any productive thoughts on which route I should take would be greatly appreciated!

 

[Gastrapathy]

Nothing was mentioned about 'special treatment'. And 'thinking outside of the box' was referring to those in the HPSP office who can only imagine a MedPeds doctor filling either a pediatrics or internist slot at one time versus the integrated positions offered at civilian hospitals. But maybe the 3 hospitals affiliated with my school are unique - the MedPeds physicians on staff float between the ICU and PICU and inpatient wards in both IM and Peds.

I was hoping the military would see the cost benefit of this integrated thinking. Plus, the capability of providing a better continuity of care for special needs patients (i.e. in the Exceptional Family Member Program) as they transition from pediatricians to internists. Just my thoughts.

And I am still interested in MedPeds so any productive thoughts on which route I should take would be greatly appreciated!

What cost-benefit? You can only be in one place at one time. You must realize the EFMP argument is really weak. Beyond that, neither Peds nor IM training focus on adolescent medicine.

I don't think there is a route by which you can do this other than to pray that they'll make an exception and grant you a deferment. Good luck with that.

 

[Scooby007]

But there's no integration involved. It's a hodgepodge of two completely seperate specialties slapped together for no apparent reason, ala EM/IM, IM/Psych, FP/Psych.

The integration that I have seen is when MedPeds doctors are working in Primary Care. Some of the cases that an FP will refer to IM or Pedi docs can be treated by the MedPeds (where the cost-benefit comes into play) without the referral. There is a good article on this here.

I like the original suggestion of doing two residencies. Honestly, I think that's what everyone interested in both should do. It is ******ed that we can take a 3y IM program + a 3y Peds program and come up with a 4y integrated program.

Even this option sounds good too... Is doing a second residency discouraged or difficult in the military? I am very interested in both programs and stressed on what to do.

Thanks for the productive comment!

 

[NavyFP]

Just to add my 2 cents.

A big problem with Med/Peds is that there are not the integrated clinics/inpatient services to utilize Med/Peds outside of FP services. You practice one or the other and may be permitted to dabble in the other if workload allows. Since the services tend to have no shortage of Pediatricians, that would mean assignment to an IM clinic. You could work on the FP service, but would lack the OB skills to manage the team and make you less useful. The idea of FPs referring IM/Peds patients to a general IM or Peds doesn't usually sit well with military FPs unless we are trying to dump the patient. I have managed all kinds of complicated patients with subspecialty input. The EFMP issue doesn't fly either as most will transition out of the system before they would really need an internist. We do very little inpatient care on deployment so no benefit there. Cost benefit? It takes 3 years to train to train the FP vice 4 for the Med/Peds to fill the same role .


You would likely be allowed to complete both residencies if you did the Peds residency first. You would then practice as a Pediatrician for 3 years and come back for 3 more years of Internal Medicine. You would spend the next 3 years practicing as an internist. Second residencies requests are decided by the need of the specialty in which you are currently trained versus the need for the specialty you want. As stated earlier, the services tend to be overmanned in Peds and undermanned in IM.

 

[Scooby007]

Just to add my 2 cents.

A big problem with Med/Peds is that there are not the integrated clinics/inpatient services to utilize Med/Peds outside of FP services. You practice one or the other and may be permitted to dabble in the other if workload allows. Since the services tend to have no shortage of Pediatricians, that would mean assignment to an IM clinic. You could work on the FP service, but would lack the OB skills to manage the team and make you less useful. The idea of FPs referring IM/Peds patients to a general IM or Peds doesn't usually sit well with military FPs unless we are trying to dump the patient. I have managed all kinds of complicated patients with subspecialty input. The EFMP issue doesn't fly either as most will transition out of the system before they would really need an internist. We do very little inpatient care on deployment so no benefit there. Cost benefit? It takes 3 years to train to train the FP vice 4 for the Med/Peds to fill the same role .


You would likely be allowed to complete both residencies if you did the Peds residency first. You would then practice as a Pediatrician for 3 years and come back for 3 more years of Internal Medicine. You would spend the next 3 years practicing as an internist. Second residencies requests are decided by the need of the specialty in which you are currently trained versus the need for the specialty you want. As stated earlier, the services tend to be overmanned in Peds and undermanned in IM.

Great advice - I appreciate your perspective. Thank you!

 

[J-Rad]

I would be curious to see what a few (likely civilian) Med-Peds people had to say about their specialty and what they thought the specific benefit was to themselves/career/patients. But I agree that in the military probably sees little gain in having Med-Peds trained people. I could stretch and say that they might see use in the deployed environment to take advantage of the critical care skills of a pediatrician and internist (I know a fair amount of FPs get adult CCM training in residency, but few get much, if any pediatric CCM training, and I know that the pediatricians being deployed to OEF/OIF are being expected to manage critical pediatric patients in conjunction mostly with the trauma/neurosurgeons as most the pediatric cases coming in are trauma or burns). My own perception of one of the best "uses" of a Med-Peds doc is for continuity of primary care in children with complicated medical conditions as they grow into adulthood (Down's, bad CP/MR, complex CHD, etc) and as other people stated, unless they have a condition that will make them permanently under the care of the AD sponsor, then they'll transition out of military healthcare after age 18, 21, or 23 depending on the circumstance.
So for the OP you might need to figure out if you can tolerate FP or committing to 12 years in milmed (the residency-utilization tour-residency-utilization tour track...hope you like the system 🙂). Alternatively figure out what you love about IM or Peds. Maybe one can give you what you want without giving up everything you want from the other. While I've never heard of anyone doing it (probably too big a pay cut even if you have a passion for adolescent med) IM docs can do a fellowship in adolescent (as can FP docs). Alternatively, if you're interested in subspecializing, (one reason FP can be less attractive to some), a few pediatric subspecialists see a few to quite a few adults (pediatric cardiologists probably seeing the greatest number of adults). Good luck in finding the right path.

PS As the OP pointed out though, it never hurts to ask, and to ask more than one person. I know of a Navy Peds ED, who was Peds to Peds ED. I honestly can't conceive of the rationale for training a person via this route (though he is a fantastic doctor, an ED to Peds ED makes far more sense esp. when it comes to ED coverage and privileges). But someone, at one time thought it was a good idea, so maybe an a random year would say "hey, Med-Peds? M'OK".

 

[Scooby007]

Outstanding! Thanks for the input.

On a side note, I spoke with a former Surgeon General of the Army that lives near my family regarding this matter. He was suprised that the military removed the Med-Peds program (which dates the guy). He said they were valuable and it could have been a program that would benefit the military but it seems they didn't integrate them very well like some of the larger civilian teaching hospitals.

His advice was to contact the Consultants to the Surgeon General in IM and Peds to suggest the program. Also, see if something can be put together in any of the larger Army teaching hospitals between the IM and Peds departments. All of the clinical criteria for accredidation are on the professional association website for MedPeds - so the template is spelled out to allow you to sit for both boards with a 4-year program.

I know it is a long shot that any of those people will progress anything, but it never hurts to ask. Any other advice or suggestions are welcome and I appreciate the previous coments.

 

[Scooby007]

So, I did a little searching and found the website of the Pediatrics Consultant to the Surgeon General of the Army:

http://armypeds.amedd.army.mil/

Ironically, their mission statement "Pro cura infantis - Pro cura militis (For the cure of the child - For the cure of the soldier)" sums up the mission of all military doctors: To preserve fighting strength. This website mentions that when deployed, Army pediatricians practice on adults in various situations.

Why the heck do they not see the benefit of having (or allowing a deferrment) into a MedPeds program?!?!?!?! The extra year of training would mean an extra year of service owed - which does at least three positive things for the military:

1. Increases a doctor's active duty service
2. Gives him/her a broader knowledge base when deployed
3. Allows him/her to be stationed in either a Pedi or IM position to best suit the demands of the military when it is time to PCS

This makes sense to me! The illogic answers continue to amaze me. I was in the service before going to medical school and decided to take the HPSP to continue to serve in the military. In the process, I apparently lost the ability to pursue the training of my choice. I could understand "not matching" but this is a case of not even being able to apply since a combined MedPeds program does not exist in the military anymore.

Sorry to vent, but I am frustrated. I was hoping to make a career of military medicine, but it is discouraging to hit a roadblock this early along my path.

Any thoughts? Also, does anyone know of any Army MedPeds doctors? If so, how were they able to train in the combined program? (I have heard of people who knew of MedPeds docs in the military...)

Argh...